Limb-sparing resection of axillary soft tissue sarcomas

• Published in: Operative Orthopädie und Traumatologie Vol. 35; no. 6; pp. 377 - 389
• Main Authors: Stauss, Ricarda, Graulich, Tilman, Omar Pacha, Tarek, Omar, Mohamed
• Format: Journal Article
• Language: German
• Published: Germany 01-12-2023
• Subjects: Humans; Limb Salvage - methods; Plastic Surgery Procedures; Retrospective Studies; Sarcoma - pathology; Sarcoma - surgery; Shoulder - pathology; Shoulder - surgery; Soft Tissue Neoplasms - pathology; Soft Tissue Neoplasms - surgery; Treatment Outcome; Soft tissue sarcoma; Axillary space exploration; Limb salvage; Musculosceletal tumor; Oncological resections
• ISSN: 1439-0981
• DOI: 10.1007/s00064-023-00824-8

For patients with soft tissue sarcoma, surgical resection is a key element of curative therapy. Surgery is performed as a wide resection with microscopically negative margins (R0 resection) and as limb-sparing procedure whenever possible to preserve maximum function.
Soft tissue sarcoma, metastases.
Extensive disease with major neurovascular involvement, placement of biopsy tract necessitates extensive resection, palliative care.
Extended deltopectoral approach. Release of pectoralis major and minor tendons. Vascular and neurologic exploration, identification of the axillary vessels and brachial plexus, placing of loops around major structures. Mobilization of these structures to achieve adequate exposure. Clipping of vessels entering the tumor. Tumor resection, suture marking for histological analysis. Soft tissue reconstruction by transosseous reinsertion of the pectoralis minor to the coracoid process. Drill channel placement, transosseous refixation of the pectoralis major to the humerus.
Shoulder abduction brace for 6 weeks, passive mobilization for 6-12 weeks followed by active mobilization. Compression sleeve. Oncological follow-up.
Between 2017 and 2022, wide resection was performed in 6 consecutive cases including 4 primary soft tissue sarcomas and 2 metastases. Primary R0 resection was achieved in 100%. Mean follow-up was 22.5 months (3-60 months). There were no local recurrences. Mean active shoulder abduction was 135.0 ± 41.4° (90-180°). Neurological deficits were not observed. Mean subjective shoulder function was 80.0 ± 21.0% (50-100%). The mean Musculoskeletal Tumor Society (MSTS) score was 89.5% (32-100%), indicating good functional outcome in the study cohort.